The boxer directs a hit underneath the target's right pectoral behind the ribcage. To add power, the boxer twists his waist while keeping his free hand tucked in, placing his weight on his forward leg; this allows his back and leg muscles to add momentum to the punch. A well-executed liver blow should have a slight delay between the twisting of the waist and the launching of the punch. Boxers who are experts at the liver blow, such as Ippo, can perform the punch so swiftly and compactly that the delay is not noticeable at all.

If enough strength is put behind the attack, it ruptures the liver, causing internal bleeding which leads the affected individual to experience nausea and disorientation. For hard punchers like Ippo, it can also crack the ribcage of his opponents. It is an especially effective attack in stopping a fast-moving opponent, typically out-boxers. This move is frequently favored by fighters who rely on strength during fights, such as Makunouchi Ippo in his fight against Mashiba Ryo in the East Japan Rookie Championship finals.

The major flaw of the liver blow is twofold; it is an extremely close-range attack, requiring the boxer to stand toe-to-toe with the opponent in order to target the desired body part, and at the same time the boxer needs enough space to rotate their hips and arm, otherwise the punch will have much less power. The liver blow can therefore be avoided by either staying at medium range and beyond, or via clinching. Again, Ippo is remarkable in that he can perform a full-power liver blow even on a clinching opponent.